November 16, 2005

For a sizable group of people in their 20's and 30's, deciding on their own what drugs to take - in particular, stimulants, antidepressants and other psychiatric medications - is becoming the norm. Confident of their abilities and often skeptical of psychiatrists' expertise, they choose to rely on their own research and each other's experience in treating problems like depression, fatigue, anxiety or a lack of concentration. A medical degree, in their view, is useful, but not essential, and certainly not sufficient.

They trade unused prescription drugs, get medications without prescriptions from the Internet and, in some cases, lie to doctors to obtain medications that in their judgment they need.

30 comments:

Reefer madness may well have taken hold with some of the older generation. They may not be as open as the younger generation is about swapping pilld. I know several older people who do swap and dispense pills. Conversely are the doctors who will presribe what a patient asks for, though they are not abundant in my opinion.

All that research takes the fun out of it, but I understand they feel they *need* them. The right to self-medicate, is that one of those hidden in the Constitution? Well at least we know how the 9th Circuit would rule.

I am really somewhat ambivalent on this (btw, interesting discussion on by Eugene today on Volokh on misusing words, including "ambivalent"). A lot of physicians really don't know all that much about the drugs they prescribe. That is why some practices are bringing in PharmDs to handle such. Often, they seem to depend on the drug reps - who have a serious conflict of interest (i.e. they are paid for selling the stuff). Add to this that there is a lot of drug information on the Internet these days. So, I would expect that at least some patients have a better idea of what meds they need than do their physicians.

On the other hand, I have seen it abused. I know of one older guy who fires his doctors if they don't give him the diagnosis that he expects. He tells them what is wrong with him, and they had better agree, or they get fired. Yes, he is smart, and does homework. But he has been wrong as often as he has been right.

My point in the later is that with the ease of information acquisition today on the Internet, we sometimes discount the expertise of people who have spent their lives in a certain area. Sometimes, they have forgotten more about your malady than you have learned about it on the Internet.

In the end though, I come down on the side of these kids. My libertarian side shows through again. If they want to kill themselves this way, then, fine, that is (IMHO) their perogative.

Bruce Hayden wrote: My libertarian side shows through again. If they want to kill themselves this way, then, fine, that is (IMHO) their perogative.

If these people have insurance, they are quite likely going to stick someone else for the bill if anything goes wrong, not to mention driving up costs for their carriers by getting unneeded prescriptions.

Does your libertarian side think it's okay if we throw all of these people out of their insurance programs, because they're bad risks and are abusing the system?

Well, what did you expect? As long as our government permits its subjects to eat and drink whatever they choose, some of them will be tempted to extend those liberties of ingestion to pharmaceuticals. Government must step up to its responsibility to completely and ruthlessly control every aspect of our lives...otherwise horror stories like this will continue.

If these people have insurance, they are quite likely going to stick someone else for the bill if anything goes wrong

While I don't necessarily disagree, that is a pretty slippery slope argument. Using that logic, I could go on all day about people living in flood plains, eating bacon, driving a car without airbags, jaywalking, parachuting, scuba diving, etc.

Dave, Adderal is most definitely cheating for the LSAT and or Bar exams...you'd be suspended 50 games by MLB.

On a serious note, is it possible that this is a consequence of the generally irrational and possibly completely corrupt stance of our government towards drugs of all sizes?

Prof. A brings up marijuana and that's a useful point in that I don't think there is a disagreement among rational people that treating pot and crack in roughly equivalent fashions while pot and alcohol are treated vastly differently is, at best, arbitrary. Once you are there in becomes easier to say "well, I can find out just as much about Welbutrin/Ambien, hell why not Oxycontin, as my MD, so who needs him and his gov't perscription pad?"

I meant crazy in the sense that I am a free-market libertarian who really trusts people to make their own decisions, even when those decisions may endanger themselves (and should only be punished if they endanger others in the process).

From the viewpoint of most people (it would seem) that makes me crazy, so I said that upfront, as far as meds go, sorry, don't need 'em, don't take 'em (not even aspirin for a headache).

(and yes, I know you were just cracking wise, I set them up, so that someone else can knock them down)

I do detect a certain degree of defensiveness from the medical profession when this subject comes up though, it would seem that they fear that most of their customers see them as mere pill dispensaries and should their gate-keeping function be ended then most visits to doctors would be cancelled.

The New York Times finally managed to identify a "trend", in my opinion, rather than just a "small but growing" population. I see this all the time among my friends (and I'm not saying I haven't been a recipient or a middleman from time to time.)

The question, in my mind, is this: If you can basically call up a doctor for the express purpose of having him prescribe something to you, as Dave accurately described, why not simply attain the pills through a friend? It doesn't seem to me like the doctor is doing much more than going through the motions.

XWL, my defensiveness is coming from the employer side of the arguement. If people want to make their own medical decisions, fine. But don't expect the employers and insurance carriers to pay for the additional risks of such behavior.

If this becomes a larger trend expect some companies to drop their medical insurance (or at least curtail their drug benefits) and expect for consumers to pay even more in terms of premiums, co-pays, co-insurance, etc. Just because the medical inflation trend has been bad doesn't mean it can't get worse.

I'm with XWL. I don't have a problem with this. I would never start taking psychiatric medications without seeing a doctor, but if someone else wants to pop pills on his own, I think he should have the legal right to do that.

Great idea, XWL. Now all you have to do is get everyone to drop their insurance (the carriers place too many barriers in the way of people excercising their free choices), get the government to close down Medicare and Medicaid, and we'll be on our way to truly free markets in health care!

I think I'll read up on do-it-yourself surgery. I'm thinking of opening a surgical practice in the newer freer marketplace. Victoria, got any good book recommendations on thoracic surgery?

My fiancee is in her residency for Psychiatry and there are a few things she has mentioned worth passing along - 1) implicit in psychiatric medecine are issues of diminished capacity 2) GPs tend to not keep current with Psych meds and so many folk who are prescribed by their family physician are on older less effective drugs or drugs with more harmful side effects than necessary 3) she wishes all she did was give pills to pop 4) many folk are "just axis 2" - which basically means that they have no serious psych problems besides personality disorders 5) there are many scary outcomes if the diagnoses is wrong - certain neurological difficulties present the same as psych disorders - it would suck to take paxil for your mood and have it turn out you had a brain tumor. 6) crazy folk tend to run in packs - a person with psych issues probably has crazy friends and family - it might be good to have someone outside of their life monitoring their medical/psychiatric condition. All this is moot since I can have my fiancee give me drugs - best of both worlds! (Actually, she won't prescribe me anything - stupid ethical woman!)

It is what is called in the political trade: rent seeking. i.e. only a doctor can tell you what you need and only a pharmacist can give it to you. Assuming prior government approval for the drug in question. Which is why big pharma loves the FDA. With the DEA a close second.